Embattled Nursing Homes Call Mandate Staffing Report ‘Tone Deaf’


Nursing homes, grappling with record staffing shortages and a rise in Covid-19 infections, will soon have to release their staff turnover rates and weekend staffing levels for nurses, a decision designed to help consumers select quality installations.

A large part of the new information expected to post this month on Medicare.gov Compare treatments website will not be flattering. Indeed, “every nursing home in the country, for the most part, is struggling” with high staff turnover and low staffing, said David Grabowski, professor of health policy at Harvard Medical School.

The new data is expected to show what recent research has already found, which is that the numbers of registered nurses, licensed practical nurses and nurse aides typically decline on weekends. And many nursing home workers leave their jobs within a year. Both of these issues are closely linked to poor quality care.

As nursing homes attempt to restore public trust after Covid-19 killed at least 186,000 long-term care residents, the reporting warrant could provide an untimely black eye for an industry already on the ropes .

“It really feels like a big punch for nursing homes that are really struggling right now,” Grabowski told attendees during a recent web briefing hosted by LeadingAge, which represents aging service providers with a goal. non-profit.

The new reporting mandate is reasonable and useful for consumers, Grabowski acknowledged. “It’s really a bad time.”

“Deaf of Ear”

The industry agrees. Nursing homes have lost 234,000 employees, or 15% of their workforce, since the start of the pandemic, according to the American Health Care Association and the National Center for Assisted Living. “The addition of this reporting requirement when we are in the midst of the worst labor shortage the nursing home industry has ever faced is tone deaf,” the groups said in a statement to Bloomberg Law.

Starting in July, new data from about 14,000 nursing homes across the United States will help determine a facility’s overall quality rating from the Centers for Medicare & Medicaid Services. Under the new requirement, facilities must report the number of administrators who left in the past year, the percentage of registered nurses who left, and the total number of all nurses who left. Weekend staffing levels for registered nurses, licensed practical nurses and certified nurse aides must also be reported.

Last year, Grabowski co-wrote to research which found that nearly all direct care staff in the typical nursing home left their jobs in 2017 and 2018. The predicted turnover rate of 94% was much higher than previous research had shown and s is likely to be made worse during the pandemic.

A 2019 to study by Grabowski and other Harvard University researchers found that 91% of nursing homes met federal RN staffing levels less than 60% of the time. The numbers of registered nurses, licensed practical nurses and nurse aides were reduced at night and on weekends. Overall, 54% of institutions achieved expected staffing levels less than 20% of the time, according to the study.

“We’ve long known that staffing levels are worse on weekends, and this data will validate that,” Lori Smetanka, executive director of Consumer Voice for Quality Long-Term Care, said in a statement. “Furthermore, high turnover rates, which average about 100% of staff, are indicative of lower quality in institutions. This information will help consumers make more informed decisions about choosing long-term care.

Staffing, reporting requirements

Federal law requires nursing homes to provide “licensed nursing services” that are “sufficient” to meet the needs of residents. But Medicare only requires nursing homes to have at least one registered nurse on duty for eight consecutive hours a day.

The CMS said the new reporting requirements flesh out a policy it would have implemented last year had it not been for the pandemic. In March 2021, a report by the Office of the Inspector General of the Department of Health and Human Services found that the Care Compare website could better serve the public and state inspection agencies if it included self-reported turnover data nursing home staff.

“CMS had taken steps to introduce a revenue metric on Care Compare at the end of 2020, including consulting with external experts to define and refine a potential metric, however, due to the Covid-19 pandemic, this timeline has changed. been delayed,” the agency wrote. in a response letter to the OIG. “CMS will continue to move forward with reporting nurse turnover and seniority.”

The Care Compare site has been publishing nursing home staffing data for more than a decade, but as of August 2020, the HHS OIG advised the CMS provides information on how a property’s weekend staffing levels compare to those of other properties with similar quality ratings. In its March 2021 report, the OIG “recommended that CMS measure nursing staff turnover as soon as possible” due to the impact Covid was having on care home monitoring.

A call for a higher refund

While staffing and job retention have been longstanding industry issues that have only worsened during the pandemic, the AHCA/NCAL said the new reporting requirement is the wrong approach. He called for higher Medicaid reimbursements and more targeted funding to help providers deal with rising labor, equipment and Covid testing costs.

“While we support transparency and agree that staff hours and turnover measures are important, more reporting will not solve this problem,” the group’s statement read.

Grabowski agreed, telling webinar attendees that the “ultimate solution” to the industry’s workforce crisis is higher Medicaid reimbursements and additional federal funding.

“We need to spend more money on paying our staff a living wage, and that’s a matter of policy. It’s not a nursing home issue,” Grabowski said. “It’s really something we need to do at the political level.”


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